
CODEINE PHOSPHATE
Indications and dose
Acute diarrhoea
By mouth
- For Child 1217 years
30mg 34 times a day; usual dose 1560mg 34 times a day.
- For Adult
30mg 34 times a day; usual dose 1560mg 34 times a day.
Mild to moderate pain
By mouth
- For Adult
3060mg every 4hours if required; maximum mg per day.
By intramuscular injection
- For Adult
3060mg every 4hours if required.
Short-term treatment of acute moderate pain
By mouth, or by intramuscular injection
- For Child 1217 years
3060mg every 6hours if required for maximum 3 days; maximum mg per day.
Dry or painful cough
By mouth using linctus
- For Adult
1530mg 34 times a day.
Important safety information
For all OPIOIDS
For CODEINE PHOSPHATE
MHRA/CHM advice (July ) Codeine for analgesia: restricted use in children due to reports of morphine toxicity
Codeine should only be used to relieve acute moderate pain in children older than 12 years and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen alone. A significant risk of serious and life-threatening adverse reactions has been identified in children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy:
- in children aged 1218 years, the maximum daily dose of codeine should not exceed mg. Doses may be taken up to four times a day at intervals of no less than 6 hours. The lowest effective dose should be used and duration of treatment should be limited to 3 days
- codeine is contra-indicated in all children (under 18 years) who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea
- codeine is not recommended for use in children whose breathing may be compromised, including those with neuromuscular disorders, severe cardiac or respiratory conditions, respiratory infections, multiple trauma or extensive surgical procedures
- codeine is contra-indicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers)
- codeine should not be used in breast-feeding mothers because it can pass to the baby through breast milk
- parents and carers should be advised on how to recognise signs and symptoms of morphine toxicity, and to stop treatment and seek medical attention if signs or symptoms of toxicity occur (including reduced consciousness, lack of appetite, somnolence, constipation, respiratory depression, pin-point pupils, nausea, vomiting)
MHRA/CHM advice (April ) Codeine for cough and cold: restricted use in children
Do not use codeine in children under 12 years as it is associated with a risk of respiratory side effects. Codeine is not recommended for adolescents (1218 years) who have problems with breathing. When prescribing or dispensing codeine-containing medicines for cough and cold, consider that codeine is contra-indicated in:
- children younger than 12 years old
- patients of any age known to be CYP2D6 ultra-rapid metabolisers
- breastfeeding mothers
Contra-indications
For all OPIOIDS
For CODEINE PHOSPHATE
Acute ulcerative colitis; antibiotic-associated colitis; children under 18 years who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea; conditions where abdominal distension develops; conditions where inhibition of peristalsis should be avoided; known ultra-rapid codeine metabolisers
Cautions
For all OPIOIDS
For CODEINE PHOSPHATE
Acute abdomen; cardiac arrhythmias; gallstones; not recommended for adolescents aged 1218 years with breathing problems
Cautions, further information
Variation in metabolism
The capacity to metabolise codeine to morphine can vary considerably between individuals; there is a marked increase in morphine toxicity in patients who are ultra-rapid codeine metabolisers (CYP2D6 ultra-rapid metabolisers) and a reduced therapeutic effect in poor codeine metabolisers.
Interactions
Pregnancy
For all OPIOIDS
Breast feeding
Manufacturer advises avoid (recommendation also supported by MHRA and specialist sources). Present in milk and mothers vary considerably in their capacity to metabolise codeine; risk of opioid toxicity in infant.
Hepatic impairment
With oral use
Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
With intramuscular use
Manufacturer advises avoid.
Dose adjustments
With oral use
Manufacturer advises dose reduction in mild to moderate impairment.
Renal impairment
Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.
Treatment cessation
For all OPIOIDS
Prescribing and dispensing information
For all OPIOIDS
For CODEINE PHOSPHATE
BP directs that when Diabetic Codeine Linctus is prescribed, Codeine Linctus formulated with a vehicle appropriate for administration to diabetics, whether or not labelled Diabetic Codeine Linctus, shall be dispensed or supplied.
Patient and carer advice
For all OPIOIDS
For CODEINE PHOSPHATE
Medicinal forms
There can be variation in the licensing of different medicines containing the same drug.
Forms available from special-order manufacturers include: oral suspension, oral solution, solution for injection
Tablet, Oral solution, Solution for injection
Tylenol with Codeine Overdose
What is acetaminophen with codeine overdose?
Acetaminophen with codeine is a prescription pain medication. An overdose occurs when someone takes too much of this drug. An overdose is very dangerous and can be fatal.
If you think you or someone you know may have overdosed, call or the National Poison Control Center at immediately. Be ready to tell first responders:
- the name of the medicine ingested
- weight and age
- how much medicine was taken
- when the medicine was taken
- if the medicine was prescribed to the person who took it
What causes an acetaminophen with codeine overdose?
The prescribed dose of acetaminophen with codeine is based on your weight, age, and how much pain you’re experiencing. If you take more than you’re prescribed, you could overdose.
If you take too much of the medicine, the chemicals in the drug can cause you to not think clearly. You can help remember when to take your medicines and how much to take by:
- making notes on a calendar
- keeping medicines in a weekly pill organizer
- asking someone to remind you
Some people may take acetaminophen with codeine because it makes them feel high. This isn’t a safe use of this medicine. Only people who’ve been prescribed acetaminophen with codeine should take it, and it should always be taken exactly as prescribed.
Dangers to children
Keep medicines out of reach of children. Ask your pharmacist for childproof packaging.
A breastfeeding baby can overdose on acetaminophen with codeine if their mother is taking the medicine. Nursing mothers taking acetaminophen with codeine should consider bottle-feeding their babies. If this isn’t possible, they should immediately call or the National Poison Control Center at if their baby:
- is more drowsy than usual
- has difficulty breastfeeding
- has difficulty breathing
- has pale skin
Treatment for overdose
Call or the National Poison Control Center and listen carefully to their instructions. They may send emergency medical care. Someone who has overdosed on acetaminophen with codeine could be sent to the hospital.
Hospital treatments include:
- activated charcoal
- artificial respiration
- intravenous fluids
- a tube through the mouth into the stomach (stomach pumping)
People who’ve overdosed on acetaminophen with codeine may also receive two medicines to reverse the effect of the drugs:
- naloxone (Narcan)
- N-acetyl cysteine
Outlook for acetaminophen with codeine overdose
The faster you get medical help, the sooner you’ll recover. Recovery can take a day or two.
If your liver is affected, recovery could take longer. Long-term liver damage is possible because toxins are released into your system when acetaminophen is broken down into other chemicals by your liver.
Addiction to codeine
Codeine can be habit-forming. Taking too much codeine can cause:
Long-term use can cause dependency and addiction to the drug. If you think you’re addicted to codeine, you should see your doctor right away to discuss your treatment and rehabilitation options.
Preventing an overdose
To avoid an overdose and protect others:
- only take medication prescribed for you
- follow your doctor’s orders and dosage instructions
- keep all medicines out of the reach of children
Single dose oral codeine, as a single agent, for acute postoperative pain in adults
(2) Zomepirac 50 mg, n = 30
(3) Zomepirac mg, n = 29
(4) APC+codeine 60 mg, n = 29
(5) Placebo, n = 30
(1) 8/30
(5) 6/30
Mostly minimal CNS
(2) Paracetamol mg, n = 41
(3) Paracetamol + codeine /60 mg, n = 41
(4) Placebo, n = 17
(1) 8/22
(2) 21/42
(3) 15/42
(4) 9/19
(2) Propiram 50 mg, n = 20
(3) Propiram mg, n = 20
(4) Placebo, n = 20
(1) 5/2
(4) 2/20
(2) Ibuprofen mg, n = 38
(3) Ibuprofen + Codeine /60 mg, n = 41
(4) Aspirin mg, n = 38
(5) Aspirin + codeine /60 mg, n = 45
(6) Placebo, n = 46
(1) 11/38
(6) 5/46
(2) Ciramadol 30 mg, n = 13
(3) Ciramadol 60 mg, n = 12
(4) Placebo, n = 14
(2) Aspirin mg, n = 40
(3) Propiram 50 mg, n = 40
(4) Placebo, n = 40
(2) 14/40
(3) 18/40
(4) 7/39
(2) Naproxen sodium mg, n = 38
(3) Naproxen sodium + codeine /60 mg, n = 38
(4) Aspirin mg, n = 36
(5) Placebo, n = 42
(5) 7/46
(2) Meclofenamate mg, n = 41
(3) Meclofen/codeine 50/30 mg, n = 40
(4) Meclofen/codeine /60 mg, n = 40
(5) Placebo, n = 40 for efficacy: 37, 41, 39, 39, 39
(5) 0/40
(2) Meclofenamate mg, n = 41
(3) Meclofenamate mg, n = 40
(4) Placebo, n = 41
Did not differ between groups
(1) Codeine 60 mg, n = 16
(2) Ibuprofen mg, n = 12
(3) Placebo, n = 16
(2) Paracetamol mg, n = 28
(3) Paracetamol + codeine /60 mg, n = 30
(4) Placebo, n = 30
(2) Diflunisal mg, n = 41
(3) Diflunisal + codeine /60 mg, n = 40
(4) Placebo, n = 40
(4) 1/40
All somnolence
(2) Ketoprofen 25 mg, n = 24
(3) Ketoprofen 50 mg, n = 27
(4) Ketoprofen mg, n = 27
(5) Placebo, n = 24
(1) Codeine 60 mg, n =
(2) Placebo, n = Other surgery:
(1) Codeine 60 mg, n =
(2) Placebo, n =
(2) Aspirin + codeine /60 mg, n = 41
(3) Tramadol 50 mg, n = 49
(4) Tramadol mg, n = 49
(5) Placebo, n = 27
(2) Propiram fumarate 50 mg, n = 41
(3) Placebo, n = 39
(2) Ibuprofen mg, n = 38
(3)Ibuprofen + codeine /30 mg, n = 40
(4) Ibuprofen + codeine /60 mg, n = 40
(5) Placebo, n = 40
(1) 0/37
(5) 0/40
(2) Piroxicam 20 mg, n = 50
(3) Placebo, n = 50
(1) 10/51
(3) 25/50
(2) Ciramadol 15 mg, n = 13
(3) Ciramadol 30 mg, n = 15
(4) Ciramadol 60 mg, n = 20
(5) Placebo, n = 15
(5) 1/15
considered at least poss rel to study drug
(2) Meclofenamate mg, n = 55
(3) Meclofenamate mg, n = 55
(4) Placebo, n = 52
Codeine is a synthetic drug derived from morphine. It was first discovered in by Pierre Robiquet, a French chemist. Small amounts of codeine are actually found in the opium poppy from which morphine is extracted, although modern formulations make codeine from pharmaceutical-grade morphine.
How does it work?
The drug works by interacting with opiate receptors in the brain, reducing the sensation of pain in the same way as morphine and the related (illicit) drug heroin. This is why drugs related to morphine and codeine are known as opiates.
Codeine is a much weaker narcotic analgesic than morphine – approximately one-tenth the potency.
It doesn’t work for everyone
About 8% of the population is unable to metabolise codeine to its active metabolite, morphine, leading to a poor response to codeine. This is not in itself dangerous (these people just have to change analgesics), but there are also a small number of people (about 5%) who metabolise codeine to morphine at a much larger extent.
These people are at an increased risk of toxicity caused by the increased amounts of morphine produced.
Availability
In Australia, codeine is available over the counter by itself or in combination with a range of other drugs in low-dose formulations (8mg, 15mg) such as with the anti-inflammatory drug ibuprofen. Stronger tablets (30mg) are only available by prescription.
Its main use is to relieve pain and to treat minor aches, including headaches, but only for a short term. Doctors can prescribe a higher-dose form (forte formulations containing 30mg codeine) for more significant aches and pains.
Low-dose forms are also used to treat coughs (antitussive), often available as syrup or linctus. Codeine can also help reduce the effects of nausea and diarrhoea without causing significant side effects.
Cost
Codeine is the most widely and commonly used prescription opiate in the world. It is relatively cheap when obtained over-the-counter, often for less than A$10 for low-dose packs.
Higher costs are associated with combination tablets and larger pack sizes. Prescribed codeine phosphate 30mg is available in a pack size of 20 tablets costing a maximum of A$ under the PBS.
Doses
It is taken orally with doses ranging from mg but may range up to mg daily. Once consumed this drug will act for approximately three to six hours.
Codeine is available in combination preparations such as Nurofen Plus, which also contains the anti-inflammatory drug ibuprofen; and in cold and flu preparations with paracetamol and decongestants. Codeine is also found in combination with paracetamol and doxylamine (for example Mersyndol). This is recommended for the treatment of tension headache, migraine, and it may be useful in controlling fever.
The drug should not be used for prolonged periods, particularly without supervision and control by a medical practitioner. The main risk is the development of dependence (addiction) and tolerance that can lead to use of higher doses, particularly in patients whose pain is not well managed.
Codeine may not be the best treatment for a given condition; hence medical supervision is always warranted when longer-term use is sought. Risks are also associated with products that combine codeine with other drugs. Prolonged use of high-dose codeine/ibuprofen combinations has been linked with gastrointestinal disorders and renal failure. Combinations with paracetamol can also lead to liver damage.
Side effects
Codeine may cause red, itchy skin rashes, difficulty breathing, faintness, constipation, hayfever, and swelling of the face or throat.
Serious side effects include unusual sleepiness, confusion, and difficult and noisy breathing. The drug can suppress the cough reflex and create breathing difficulties, particularly when asleep.
Adverse drug combinations
Alcohol (other than low doses), other analgesics, benzodiazepines (Valium, Temaze, Serepax), other sedatives and sleeping tablets, and some antidepressants interact with codeine and should be avoided since they may enhance the sedative actions.
Use of codeine is not advised in people who have had recent biliary tract surgery (unblocking of the bile ducts), have suffered a recent head injury or conditions that raise the pressure within the head, or are suffering from diarrhoea caused by poisoning or antibiotics.
High 90 mg codeine
Never been there. I agreed and we got together on the same day and got on the car and drove off. Our car is the most ordinary, Zhiguli of the 3rd model. oldbut completely normal.
Understanding codeine addiction – Dr Adrian ReynoldsOn the way, we chatted about the time spent and agreed that we had gone very well and would have to repeat it. 09: 30Hi. Where are you.
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